According to the World Health Organization’s ICD-10 Classification of Mental and Behavioral Disorders, Anorexia nervosa is a disorder “characterized by deliberate weight loss, induced and sustained by the patient” (ICD, 2007). It is not just a loss of appetite but an eating disorder. The disorder is associated with undernutrition of different levels of severity, followed by secondary endocrine and metabolic changes and varying problems of bodily function.
At least two types of anorexia nervosa are being acknowledged: the restricting type and the binge-eating or purging type. The latter mean that the person has regularly practiced self-induced vomiting or the misuse of laxatives, diuretics, or enemas. The restricting type of people having anorexia nervosa tends to keep the body weight below a minimal normal level either by exercise or control of food intake, or both.
Most commonly the eating disorder of anorexia nervosa occurs in adolescent girls and young women. Adolescent boys and young men may also be affected. Another groups of risk are the children approaching puberty and older women approaching the menopause.
The causes of this disorder are still elusive, however it is commonly believed that modern sociocultural and biological factors contribute to the expansion of anorexia nervosa, especially among vulnerable youngsters.
The anorexia nervosa is claimed to have occurred in the 19th century. The typical fatness phobia first appeared among the daughters of the Western bourgeois and remained for some time a condition predominantly affecting Western European and North American female teenagers from relatively affluent families (Jilek, 2001). Later this eating disorder spread over the whole Europe, affecting young women of all socioeconomic classes. The 1960s contributed most to the cult of thinness with models like Twiggy promoted and popularized by the media. Further heavy Westernization spread the “ideal beauty” parameters to the rest of the world, making anorexia nervosa a global disorder.
Anorexia nervosa is diagnosed basing on parameters stated in The Diagnostic and Statistical Manual of Mental Disorders in the United States or in the ICD-10 Classification of Mental and Behavioral Disorders of the World Health Organization in Europe, the latter being generally the same but adding several other parameters.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) determines that among the criteria of this eating disorder are the intense fear of gaining weight or becoming fat (even though the patient may be underweight), a disturbance with the body weight or shape, its influence of self-evaluation or denial of the low body weight possible impact on health, refusal to maintain body weight at or above a minimally normal weight for age and height (less than 85% of that expected) and amenorrhea (absence of menstrual cycles, at least three months in a row) (DSM-IV-TR, 1994).
The World Health Organization pronounces that all the following criteria are necessary in order to diagnose the anorexia nervosa: first of all, the body weight should be at least 15% below that expected (either lost or never achieved), or Quetelet’s body-mass index should be 17.5 or less; secondly, the weight loss should be self-induced by avoidance of “fattening foods” and vomiting, purging, use of appetite suppressants and/or diuretics (either of the self-induced acts mentioned can add to the diagnosis of anorexia nervosa. ICD-10 Classification of Mental and Behavioral Disorders also states that the “body-image distortion in the form of a specific psychopathology whereby a dread of fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself” is a necessary parameter to diagnose a person with anorexia nervosa. Another parameter is amenorrhea in women and a loss of sexual interest and potency in men. In case the disorder develops in prepubertal period, the pubertal events are most often delayed or stopped (ICD, 2007).
Treatment for anorexia nervosa via nutritional rehabilitation (restoring the person to a healthy weight), psychological treatment (treating the psychological disorders related to the disorder via individual or family psychotherapy) and psychosocial treatment (elimination social causes of the disorder). Drug treatments have not been proved to be generally effective for treating anorexia (Jager, 2006), though medications might help in symptoms that often co-exist with anorexia, e.g. depression, anxiety, obsessive behavior, substance abuse, etc.
The level of mortality (both due to related causes and the suicide) is comparatively high among those suffering from anorexia nervosa, which makes this eating disorder one of the most terrible “unobvious” threats to the normal development of the society, affecting most the younger generations of the world. Certainly, something has to be done with the widely accepted “perfect body” image affecting eating behavior of psychologically sensitive humans.
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